Background: The formal availability of Pre-Exposure Prophylaxis (PrEP) in many countries is limited. An important option for men who have sex with men (MSM) to obtain PrEP is abroad, at MSM travel destinations where PrEP is easily available and affordable, such as Thailand. With PrEP sourced in Bangkok, our aim was to assess PrEP use and sexual risk-taking behavior among such MSM. Since some of the clients access PrEP for the first time, we investigated PrEP use and sexual behavior during a three- (T2) and six-month (T3) follow up compared to baseline.
Methods: MSM clients (n=126) of the Silom Pulse Clinic completed a survey on-site about PrEP use and sexual behavior in February-April 2017 (T1). Surveys at T2 (n=65) and T3 (n=48) were completed online. Mean age was 38 years (range: 22-70). The sample was internationally diverse: 97 participants (77.0%) did not live in Thailand and four (3.2%) were born in Thailand.
Results: At T1, 91 participants (72.2%) reported using PrEP informally. At T2, one participant stopped using PrEP, while 11 started using PrEP. At T2, 87.7% (T3: 88.1%) followed a daily regimen. Most reported regular HIV (87.7%) and renal function testing (80.4%). At T1, 56.5% used condoms often or always, while at T2, 67.9% (T3: 72.5%) reported lower condom use since starting PrEP. Between T1 and T2, 8 participants (12.3%) were diagnosed with an STI. At T1, recreational drugs were used by 43 participants (34.1%) during sex. At T2, since starting PrEP use, 82.5% felt less anxious when having sex, and the same proportion reported increased quality of sex life. This remained stable between T2 and T3 (repeated measures F< 1).
Conclusions: Despite not having access to formal PrEP care in their home country, the vast majority of participants managed to follow a daily regimen and to obtain necessary medical checks, and reported increased quality of sex life. Despite their relative distance to local health care provision, this specific group of “PrEP tourists” is well aware of how to use PrEP correctly. A limitation is that high dropout between T1-T2 could have led to an overestimation of daily PrEP regimens.

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